EM@3AM

A 58-year-old male presents with severe shortness of breath, productive cough, and decreased ability to ambulate at home. He has COPD and is on oxygen at home. Several days ago he noted worsening congestion, myalgias, and cough. He is now severely short of breath and unable to complete his activities of daily living.
He is hypoxemic and tachypneic. You hear decreased air movement bilaterally and distal wheezes. What’s the next step in your evaluation and treatment?

A 18-year-old male presents with chest pain and shortness of breath for several days. Approximately one week prior he was suffering from myalgia, congestion, sore throat, and fever and was diagnosed with an upper respiratory infection. Today his vitals are HR 132, RR 28, BP 92/48, T 37.8 C, and Sats 95% on RA. What should you consider, and what are your next steps?

A 65F presents to your ED with chest pain and shortness of breath. Her symptoms have been going on for several months and have been progressively worsening. She states that she has felt this way since she was diagnosed with a “blood clot in her lungs” several months ago. VS include T 37.5C, HR 103, RR 22, Pox 89% on RA. What should you consider, and what’s your next step in evaluation and treatment?

A 6-year-old male presents with rash, joint pain, and abdominal pain. VS are normal, and exam reveals palpable purpura in the lower extremities. His abdomen is not tender to palpation, and his testicles are normal. Platelets and coagulation panel are normal. What is the diagnosis?

A 52-year-old male with a history of severe liver disease, cirrhosis, and hepatitis C presents with altered mental status. His vital signs are normal, and he displays asterixis on exam, with otherwise normal neurologic exam. His ECG, head CT, and labs are normal. What should you consider, and what are your next steps?

An 18-year-old male has been found unresponsive in a house fire with severe burns. VS in the field include T 37.5C, BP 144/77, HR 110, RR 15, Pulse Ox 98% on RA. You have minutes to prepare your team to care for this patient. What’s your next step in evaluation and treatment?

A 26-year-old female presents with fevers and chills. She is febrile and tachycardic, with normal BP. You think you hear a murmur on exam, and on further questioning, she says she regularly uses IV drugs. What should you consider, and what are your next steps?

A 23-year-old male is brought in by EMS with agitation. His VS include T 41 C, HR 133, BP 182/115, RR 26, D stick 118. EMS is concerned for ingestion, and the patient is not cooperative. What’s your next step?

This week’s EM@3AM brings you a case of a patient with myalgias and dark urine after exercising.